Katsuyo Tsuda

Acute basophilic leukemia associated with the t(16;21)(p11;q22)/FUS-ERG fusion gene

We herein report a rare case of acute basophilic leukemia with t(16;21)(p11;q22) generating the FUS‐ERG fusion gene. The basophilic nature of leukemia blasts was demonstrated by cytomorphology, toluidine blue metachromasia, mature basophil‐associated antigen expression, and characteristic granules under electron microscopy. The molecular link between t(16;21)/FUS‐ERG and basophilic differentiation remains unclear.

Delayed Development of Hemolytic Anemia with Fragmented Red Blood Cells and Cardiac and Renal Impairments after High-Dose Chemotherapy and Autologous Hematopoietic Stem Cell Transplantation for Malignant Lymphoma

Among 42 consecutive patients with malignant lymphoma who underwent high-dose chemotherapy (HDC) followed by autologous hematopoietic stem cell transplantation (AHSCT), 5 developed hemolytic anemia with fragmented red blood cells (HA-FrRBCs) on days 87-125 (median 107) of AHSCT. Nadir Hb levels ranged between 5.0 and 6.4 g/dL with 2.2-5.6% FrRBCs. All patients developed grade ≥3 hypoxia and heart failure, and 4 developed grade ≥3 hypertension. The ejection fraction of the left ventricle assessed by echocardiography was significantly reduced in 3 patients. Peak creatinine levels were >4 times above the baseline and estimated glomerular filtration rates were reduced to <30 mL/min/1.73 m2. One patient received plasma exchange, while the remaining 4 responded to treatment with diuretics and cardiovascular agents. Hematological parameters normalized within a median duration of 91 days after the development of HA-FrRBCs. Renal and cardiac functions gradually improved, even though renal function did not return to the baseline. HA-FrRBCs associated with cardiac and renal impairments may represent a thrombotic microangiopathy syndrome and are a delayed complication of HDC/AHSCT. The close monitoring of laboratory abnormalities and persistent treatment with cardiovascular agents and diuretics are the mainstay for the management of this condition.

DEVELOPMENT OF A COMPUTER SYSTEM (SOFTWARE) FOR THE EFFICIENT MANAGEMENT OF A PREOPERATIVE AUTOLOGOUS BLOOD DONATION OUTPATIENT CLINIC

The establishment of an outpatient clinic for preoperative autologous blood donation (PABD) is a useful measure for the promotion of preoperative autologous blood transfusion (PABT). However, in hospitals without a transfusion department, the establishment of such outpatient clinics is difficult, due to the complexity of the office work, time restrictions, and limited human resources. For the establishment of a PABD outpatient clinic in our hospital, in an attempt to guarantee the efficient management, we developed a novel computer system (the “PABTManagement System”). This system facilitates requesting and planning PABD and the registration and provision request of autologous blood products, as well as the registration of autologous blood usage or wastage. In addition, information on PABT, the clinical pathways, and product labels can be printed in this system, which contributes to the safe and efficient management of the outpatient clinic. We concluded that development of an efficient PABT computer system allows for the establishment of a PABD outpatient clinic, even in hospitals with limited human resources.